All posts by Jessica O Harper

While most NGO interventions in global health are well-intentioned, many fail to create meaningful and sustainable change. I will analyze reasons behind this phenomenon, primarily the issue of uninformed donors directing interventions, the exceptionalisation of certain diseases, the client-patron relationship that arises and finally the expectation that NGOs are a panacea to global health problems.

A fundamental issue with NGO intervention in global health is that interventions are often driven “by purse-strings” rather than actual on the ground needs (Zaidi, 270) This is seen in HIV care and in what Whyte et. al refer to as the ‘projectification’ of HIV care. This refers to the reality that the level of care a patient receives depends in large part on the program they decide or are able to join and who is funding it. “Whether clients also receive medicines for opportunistic infections and other health problems depends upon the program they have joined.” (Petryna, 155) In this chapter, Whyte et al. provide the example of some Ugandan programs providing CD4 counts but other programs to not provide this more costly test. Whether or not a program offers certain tests and services ultimately comes down to how much money they have, where this money is coming from, and how the donor wants it to be spent. So at Ministry of Health facilities funded by the Global Fund in Uganda, most clients have never had their CD4 counts measured.

The notion of patients becoming clients brought forward in Chapter 5 of Petryna and Biehl’s work is immediately unsettling as there’s a problematic power dynamic at play. “To put it bluntly, public health in this setting does not mean rights and equal opportunities for all citizens of Uganda. Rather, it means building on patron-client relationships locally, nationally, and internationally.” (145) ‘Clients’ are at the will of their patrons and the amount of money that the program they are enrolled in has from donors and NGOs. Moreover, there is a notion of reciprocity at work here as patients enter into this contractual relationship and are thus at the will of the restrictions and inconveniences imposed on them by their ‘patron’ health program.

Zaidi’s piece condemns NGOs as a band-aid fix to health care particularly in settings where the state has failed. “Because of their limited scope and reach, NGOs are no alterative to state failure.” (Zaidi, 270) Similarly, Pfeiffer also criticizes the prevailing notion in global health that NGOs are a “panacea”. This is an extremely important point to consider because most of the time, NGOs are not in a position to address the root causes of the problems that their specific intervention is designed to handle. (Zaidi, 268) Consequently, the expectation that NGOs will solve problems that a failed state is not able to address, is completely unrealistic and more importantly, unsustainable.

Chapter 6 of When People Come First, is slightly more optimistic in that Pfeiffer highlights that despite the misguided efforts of many NGO interventions in global health, we are in a state currently of “high agitation” in global health(Pfeiffer, 181). As such, there is great potential and a wide gap for innovation and major progress in the field. However, there are so many different NGO actors currently involved that reaching this potential is complicated. This concept is echoed in the Council on Foreign Relations blog post that appeared earlier this month about the WHO. Miles Kahler offers an interesting suggestion to this issue of harnessing the potential for innovation that the WHO should act as a norm-developing body. In this way, the WHO could set best practices, guidelines and norms that would significantly improve the effectiveness of many NGO interventions.

Ultimately, as is so often in discussions of global health interventions, the issue of NGO intervention comes down to a question of population versus individual. If the aim is to save a few individual lives, then perhaps NGO interventions in global health suffice as they exist. However, if the aim is to help a broader population, it’s evident from this week’s reading that NGOs are ineffective as they are expected to be a panacea and are too often constrained by misinformed donors. Global norms for the conduct of NGOs in global health interventions would help to address this shortcoming significantly.

Discussion Questions:

With such strong criticism of NGO intervention in global health, would the better alternative be for NGOs to not intervene at all? Or is some intervention, even if it is misguided, better than none?

Do you think the WHO could successfully assume the role of a norm-setting leader in global health to guide NGO practices and interventions?